Ensure Safe Motherhood for Women in Rural Nepal

Two years ago, One Heart Worldwide renovated the Gokule Health Post to enable it to function as a birthing center and provide much-needed quality MNH services to this  community. Perched on a steep slope of the Mahabharata mountain range paralleling the Himalayas, the small village is so remote that other communities in Kavrepalanchok district dismissively refer to the area as "out there." The village is only connected to the outside world by a gravel road often carried away by landslides or washed out during the monsoon season, regularly leaving people stranded for months at a time. Even in the best of circumstances, it is a 14 hour drive north to access the district hospital in Dhulikhel. Unsurprisingly, cellular network connectivity is also often unavailable. 

The Gokule region is home to the ethnic Tamang people who often shun the use of a birthing center, opting instead for a traditional in-home delivery. This is how Sunita, a newly married 19-year-old, found herself at home and two weeks overdue with her first pregnancy. She had previously walked the two and a half hours to visit the Gokule birthing center for her prenatal visit and was hoping to deliver with the help of the local Skilled Birth Attendants (SBA) that OHW had trained. But, her family, steeped in tradition, insisted that it was unnecessary.

Sunita began feeling birthing pains around 4 in the morning, but by 10 am, it was nearly unbearable. She finally built up the courage to call the birthing center where Mandira, a SBA who had helped her previously, strongly urged her to come in as quickly as possible. While Sunita knew the journey would be difficult, she had no idea just how close she or her baby would come to dying. 

Sunita was joined by her husband's aunt, and they set out on the mountainous trail. Every step caused the young mother pain. With each step, she struggled, often stopping and gasping for breath, but never giving up. Her mind was set on her baby, and she was grateful that a birthing center was even available during the pandemic.

It was 2 pm when Sunita finally arrived at the birthing center, sweating, out of breath, and nearly unconscious. Mandira immediately began checking vital signs, quickly realizing the grim condition of both Sunita and her baby . As the entire staff worked to save Sunita and her baby, it soon became clear that both mother and child would be lost without a more significant intervention. Per the local culture, Mandira first reached out to Sunita's in-laws to plead with  them to secure her transport to a larger health facility. Seeing Sunita’s condition, they agreed to try, but it would take time and finding the money would be a challenge.

By 8 pm, Sunita's condition had dangerously deteriorated and the weather was getting worse, limiting the transport option to only a rescue helicopter. Dialing One Heart Worldwide’s MNH Helpline, Mandira was able to reach Dr. Karki, a certified gynecologist who first reassured Mandira and then guided her through several tests. As the results came in, Dr. Karki grew extremely concerned about Sunita’s condition as it appeared that Sunita had preeclampsia and was  beginning to hemorrhage. Mandira decided there was no longer time to wait for Sunita's in-laws, so she and the birthing center staff began to reach out to others for help. 

As of 1 am, not a single person had answered their calls. They were beginning to feel desperate until they remembered Rabin, One Heart Worldwide's District Coordinator, who had visited the week before. Trying the number he had provided, they were relieved when Rabin answered the phone and they quickly explained Sunita’s situation. Despite the late hour, Rabin promised that OHW would do everything in their power to help.

Hiss first call was to Surya Bhatta, OHW Nepal’s Executive Director. Rabin knew that OHW lacked the resources to fund an air rescue directly, but their years of relationship building and teamwork with local officials could help secure transport for Sunita. For the next seven hours, Surya and Rabin made calls to every government official they could think of to request a medical evacuation for Sunita and . finally secured approval for a medical helicopter. Unfortunately, in the meantime -- the storm had gotten significantly worse, delaying the rescue. 

As the storm raged on, Mandira and the rest of the staff resisted their need to sleep as they did everything they could to prepare Sunita for the hospital. They continued checking and recording her vitals and worked to keep her as stable as possible. Finally, at noon, their relief was palpable at the sound of the helicopter approaching. 

Finally, nearly 36 hours l after Sunita had set out on her journey to the birthing center, she was finally admitted to the emergency ward in Kathmandu. Dr. Singh  and her team of 13 doctors immediately performed emergency  surgery to save Sunita’s life and welcome her son into the world. 

Dr. Singh later said that she was most impressed with the birthing center staff's ability to manage complications before arrival, especially praising them for properly administering drugs and timing it correctly. She said that it was clear that without the efforts of the staff and OHW, neither Sunita nor her baby would be here today.